Annuity Submission Form

NEW Annuity VA / FIA / RILA

VA - FIA - RILA
Timing and Client Contact Details
Priority*
If urgent, select a reasonable due date, explain the urgency and be sure correct delivery method is selected.
Urgency Explained:*
Please explain the reason for urgency. Be clear as to client awareness and client readiness to respond to staff outreach
Documents requested by:

MonthDayYear
Delivery Method - be sure your selection matches client expectations

Email / ElectronicPaper / MailedPaper / Team can invite client to come to office to sign with themPaper / Give docs to Advisor
Delivery Method - any special considerations for this clients signing of docs?
Client Communication - our team will contact the client as needed to fulfill submissions unless NO is selected - CAN THE TEAM CONTACT THE CLIENT?*

YESNO - this submission is for prep only
Communication- any special considerations to manage client communication?:
Rep Details
Primary Representative*
Servicing/ Submitting Representative*
Will there be a Split Rep or Rep Change?*

YesNO
Secondary Rep in Split:
Split Rep Details or Rep Change Information:
Submission Details
Are all of the following details in Redtail? This submission can not be processed without this info*

Beneficiary Names with dates of birthClient(s) SSNCurrent IncomeCurrent Expenses
What IMPORTANT details can you provide to update client records? (budget, expenses, income...)
Have all persons related to this submission been fully onboarded?*

YESNO
Has Onboarding been formally requested?

YESNO
Explain Onboarding Plan or Status since it will impact the fulfilment of this submission:
If this submission involves funds or accounts that are not managed in house, a statement is required to proceed. Does this submission involve funds or accounts that are NOT managed in house?*

YesNo
Has the statement been collected?

YesNo
Where is the statement?
scanned & emailed to team, saved in client docs, saved to RT, handed to team, on the wall?...
Please explain when and how the statement will be provided
Contract Ownership Details:
Owner Name:*

First NameMiddle NameLast Name
Owner Employment Status:*
Owner Age:*
Joint Owner Name:

First NameMiddle NameLast Name
Annuitant Name (If different than owner name):

First NameMiddle NameLast Name
Beneficiary Details: Full Names, Relationship, Primary or Contingent, %*
DO NOT include DOB, SSN. Make sure that information is in RT
Annuity Details:
Annuity Type:*
Registration Type:*
Registration:*
i.e. Trust, Roth IRA, IRA, Simple IRA
New Contract Company Name:*
New Contract Product Name:*
New Contract Rider(s):
Investment Amount:*
Rebalancing Frequency: Default for Annuities is NONE. Will only be added if requested.
Please describe custom rebalancing request
Dollar Cost Average:
Funding Source:*
How is this account being funded? Select all that apply:*

CashBrokerage AccountAnnuity401k/403b/etc
Do you know the name of their plan?*

YesNo
Plan Name of Employer Sponsored Plan:*
Does the client have access to their Form 404(a) (5)?

YesNo
Fund Fee (%)
Admin Fee (%)
Is the client currently employed at this company?*

YesNo
How much access does the plan provide?*

No AccessComputer AdvicePhone AdviceComputer & PhonePersonal Advice
Which best describes the company's size?*

Smaller (1-49 empls)Midsized (50-199 empls)Larger (200-999 empls)Enterprise (1000+ empls)
Total amount of loans against the plan? ($)*
Percentage of assets in company stock?*
Is the client satisfied with plan investment options?*

YesNo
Does the plan offer other insurance products as a benefit?*

YesNo
Does the plan offer a self-directed option?*

YesNo
Does the plan offer life insurance as a benefit?*

YesNo
Would the client like to consider a cashout?*

YesNo
VA Allocation:
RILA Allocation:
FIA Allocation:
VA Owner Age Range:

0-8081-8586-90
RILA Owner Age Range:

0-8081-8586-90
FIA Owner Age Range:

0-8081+
VA Comp Option (Owner Age 0-80):*
VA Comp Option (Owner Age 81-85):*
VA Comp Option (Owner Age 86-90):*
RILA Comp Option (Owner Age 0-80):*
RILA Comp Option (Owner Age 81-85):*
RILA Comp Option (Owner Age 86-90):*
FIA Comp Option (Owner Age 0-80):*
FIA Comp Option (Owner Age 81-85):*
Additional Comp Details
Social Security (monthly) $:*
Pension (monthly) $:*
Spouse - Pension (monthly) $:
Spouse - Social Security (monthly) $:
Individual FA Production Tracking
Money Type*
What is the current trail?*
Will this create increased or decreased revenue for the term of the investment?*
What is the annual percent of increase or decrease?*
Notes & Funding Instructions - be as detailed as possible:*
Please be specific regarding the funding of this account.
Distributions - IMPORTANT - to ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.

Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track while new account processes are in motion.
Does the account need to be setup for distributions?*
New Distribution Details*
Will this impact an already established routine distribution in the TO or FROM account?*

YesNo
Current Distribution Details*
Distribution Details- provide the team with as much detail as possible so that this process is as smooth as possible and not disruptive to the client.
Suitability/Duty of Care:

SUITABILITY QUESTIONS:
Reasons for recommending this annuity:
Main reason for recommendation:
Main reason other:
2nd reason for recommendation:
2nd reason other:
3rd reason for recommendation:
3rd reason other:
Any additional information
What SPECIFIC types of accounts/products were discussed as an alternative to this product? Submissions require the NAMES of products and NOT product types.*
Our staff will be asked to provide specific names of products and not just general types of products. Please assist by providing our team with those details.
What specifically about this product motivated you and the client to choose it?*
How long does the client intend to own the proposed product?
Does the client plan to take income from the proposed annuity?*

YesNo
At what age does the client plan on taking income?*
SUITABILITY SUPPLEMENT:
Is this annuity replacing an existing annuity?

YesNo
Does the annuity being replaced have any kind of rider the client has been paying a fee for?
If yes,
Describe other:
Why is the client is willing to "give up" this benefit they have been paying for?*
Reasons for surrender: (select all that apply)

Higher Risk/Reward PotentialHigher Interest Rate GuaranteeAdd an Enhanced Death BenefitAccess to a unique or individual investment strategyStep Up in Death BenefitReduce Market RiskAdd/Replace a Living BenefitNeeds Immediate IncomeOther
Is an income benefit rider a feature of the NEW Annuity?*

YESNO
If the new product has an INCOME BENEFIT rider, please indicate primary need.
If choosing an income benefit rider: Please indicate the primary need or intention for the distributions:
Health/Long Term Care
Charity/Giving
Travel/Leisure
Living Expenses
Other - please describe below
If choosing an income rider: please explain why guaranteeing income is important now. (The likelihood of receiving additional benefit may be decreased with longer holding periods, and potential growth may be impacted by the cost of the rider.)
Please choose all applicable:

Client's total VA/RILA/FIA holdings exceed 60% of their total investable assets [Complete Section A]Client is age 70 or greater [Complete Sections A and B]Client is age 45 or younger [Complete Section C]
Do the client's total VA/RILA/FIA holdings exceed 60% of their total investable assets? [Complete Section A]*
SECTION A - VA/RILA/FIA HOLDINGS EXCEED 60% OF TOTAL INVESTABLE ASSETS OR CLIENT IS AGE 70 OR GREATER

Indicate client's TOTAL annual expenses:
Current Expenses:*
If expenses reduced or increased during retirement, (i.e., reduced mortgage, or other) please list reduced amount:*
SECTION B - CLIENT AGE 70 OR GREATER: (Reminder: Please also complete Section A)
Is CLIENT aware of all applicable maximum age limitations for the guaranteed benefit values involved?*

YesNoOther
If choosing a lifetime withdrawal rider, is the client aware that the principal has to be fully depleted before the rider provides additional guaranteed value? (Withdrawal benefits will typically require as many as 15-20 years to recognize additional returns due to the maximum withdrawal restrictions of the benefit.)*

YesNoOther
Was there anyone else involved with this purchase decision?*

YesNoOther
Is your client 80+?

YESNO
IF THE CLIENT IS 80+ provide details on their capacity to understand the attributes and risks of the proposed annuity:*
SECTION C - CLIENT AGE 45 OR YOUNGER
If the client's employment situation changed, would he or she anticipate a need to access cash values from this annuity beyond the product and IRS restrictions?*

YesNo
Does the client have the ability to contribute to an employee sponsored retirement plan?
Yes
No*


If yes, is the client contributing or planning on contributing into the plan?
Yes
No*
Does the client intend to make continuing contributions into this proposed annuity?
Yes
No*
Notes -any additional information to help with this submission
Should be Empty:

	1a. Current Income	Source
Amount:
Amount:
Amount:
Amount:
Amount:

NEW Annuity VA / FIA / RILA

Timing and Client Contact Details

Rep Details

Submission Details

Contract Ownership Details:

Annuity Details:

Individual FA Production Tracking

Distributions - IMPORTANT - to ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.

Suitability/Duty of Care:

Reasons for recommending this annuity:

SUITABILITY SUPPLEMENT:

SECTION A - VA/RILA/FIA HOLDINGS EXCEED 60% OF TOTAL INVESTABLE ASSETS OR CLIENT IS AGE 70 OR GREATER

SECTION B - CLIENT AGE 70 OR GREATER: (Reminder: Please also complete Section A)

SECTION C - CLIENT AGE 45 OR YOUNGER